Credentialling Coordinator
Company: Innova Solutions
Location: New York
Posted on: May 28, 2023
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Job Description:
Our client, an insurance provider, is searching for a
Credentialling Coordinator. This is a contract role, where
employees are required to be onsite 5 days per week. The full job
description is as follows:Location: NYCJob Type: 6+ months
renewable contractPosition OverviewOur client is seeking an
individual to join our Credentialing Department in the capacity of
Credentialing Coordinator. This position is be responsible for
credentialing of new providers including Behavioral Health
providers & facilities, re-credentialing, and processing provider
demographic updates and changes. The Credentialing Coordinator is
responsible for document collection, review, verification, and
provider credentialing file maintenance. This position also ensures
that all credentialing supporting documentation is confidential and
maintained in a secure environment. Lastly, the Credentialing
Coordinator assists facilities and providers in understanding and
adhering to their policies and procedures regarding the
credentialing process/provider information updateScope of Role &
ResponsibilitiesMaintain communication with the credentialing
contacts at facilities and provider sites to coordinate receipt of
information required for credentialing, re-credentialing, and
update of provider credentialing informationReview provider
re-credentialing and credentialing file for completion and
presentation to the Credentialing Committee.Perform primary source
verification on required elements and in accordance regulatory
guidelines and policies and proceduresData entry and upkeep of
provider information in the credentialing and other pertinent
databasesVerify New York State OPMC, Medicare/Medicaid lists and
other pertinent databases for any currentsanctions, restrictions on
licensure and/or limitations on the scope of practice on all
credentialed providers in interim credentialing periodsVerify New
York State license registration and DEA registration status for all
credentialed providers in the interim credentialing periodsGenerate
and disseminate monthly provider credentialing updates to
appropriate departments atour office's and participating facilities
and provider groupsReview and respond to request for credentialing
information/copies of credentialing files to appropriate
departments within the organization.Generate and disseminate
provider rosters to delegated facilities, contracted group
practices etc.Perform provider roster reconciliationCreate, copy,
file, and maintain all relevant documentation into provider
credentialing folder.Maintain confidentiality of provider
credentials by filing the credentialing folder in respective
cabinets in the file rooms.Perform annual delegated file audits and
participate in pre-delegation and delegation site reviewsRespond to
inquiries from other departments relative to a provider's
credentialing statusPerforms other related tasks as directed by the
Deputy Chief Operating Officer or her designee, the Credentialing
Director or Credentialing Team LeadRequired Education, Training &
Professional ExperienceHighschool Degree required; Bachelor's
Degree preferredPrevious experience with provider credentialing
processes and proceduresKnowledge of CACTUS preferredMust be able
to handle multiple projects simultaneously.Comprehensive knowledge
of managed care with a specific emphasis on physician
credentialing.Ability to meet time-sensitive deadlines and
multi-task in a changing healthcare environment.Understanding of
credentialing activities as they relate to initial credentialing,
re-credentialing, andcredentials
modification(s).PDN-99091335-04a3-4fcb-8e86-5593348d51da
Keywords: Innova Solutions, New York , Credentialling Coordinator, Other , New York, New York
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